Use the form below to claim your prize. You are a guaranteed winner of one of the prizes listed above.

Code No. PSN20121205

Section A: Grand Prize Value Disclosure

You have been directed to this prize claim form because you are a verified and confirmed winner of one of the prizes listed above. The Grand Prize value is:

$3,500.00

Section B: Claim Information

Note: You are a guaranteed winner of one of the prizes listed above. Fill out the form below to claim your prize.

Failure to complete this form in its entirety may result in forfeiture of your prize.

aFirst Name

bLast Name

cAddress1

dAddress2

eCity

fPostal Code

gStateRegion

hCountry

Your prize notification and FreeLotto entry confirmations, daily results and sponsored advertising messages will be sent by e-mail only from FreeLotto:

iEmail

jConfirm Email

This confirmation is contingent upon meeting the age and residency requirement. These prizes are being offered by FreeLotto.com as part of a worldwide publicity campaign. Offer is valid for a limited time.

As part of a worldwide publicity campaign, we're giving away a FREE award valued up to $3,500.00. This is NOT a joke! By entering this sweepstakes you will also have joined FreeLotto.com. With daily opportunities to win over $11,000,000.00, FreeLotto is the ultimate destination for winning free money online! Since 1999, FreeLotto has awarded OVER $104,000,000.00, created 26 millionaires, and YOU COULD BE NEXT. This is a limited time offer so act fast and act now.

After you've processed your claim you'll be notified of exactly what your prize is and we will arrange delivery to you. This is totally free, we even pay the shipping. But you've got to act fast.

Best of all, after you process your claim you will have joined FreeLotto® - where you'll get a free chance at winning over $11 million in daily prizes. We've already awarded over $104 million in prizes, and you can become our next millionaire!

This promotion is sponsored by FreeLotto® and is not associated with any of the above listed brands. The above listed trademarks are the property of their respective owners. This promotion is in no way affiliated with Samsung, Dell, Apple, or Sky Auction. No purchase is necessary to enter.